Study On The Development Of The New Rural Cooperative Medical System In Western China

In recent years, due to the weak supply of western rural medical and health service and the lack of medical insurance system, it is difficulty and expensive for the western peasants to get medical service. The situation that sickness results in poor or returning to poor is getting serious, which will potentially influence the stability of the rural community. Establishing a sound rural medical insurance system centering on the new cooperative medical system, is not only the issue of social justice, but also an important economic social problem which need to pay close attention to. It is the fundamental requirements for promoting social construction with emphasis on people's livelihood, coordinating economic and social development in urban and rural areas, and constructing a harmonious society.The purpose of this study is analyzing the system foundation and the environment of western new rural cooperative medical system and exploring the key factor in the course of NRCMS experiment and root of it, by the means of economics and the sociology. In view of the existing problems, such as the lack of government's function of public medical service , the weak quality of supply of medical service ,and difficulty in continuity of rural peasants'attending the NRCMS, the emphasis should be put in improving the three mechanism including the financing and compensation mechanism, the risk supervision and Control Mechanism, and the stakeholders linkage mechanisms, in order to construct coordinated and balanced mechanism among the peasants, government and stakeholders, and promote the sustainable development of western rural cooperatives medical system.The establishment of western new rural cooperative medical system has deep theoretical foundation, such as economics, hygiene and sociology etc. It has the general attributes of medical products, and also the difference with the traditional cooperative medical system and the commercial medical insurance. In 2003, Chinese government officially launched new rural cooperatives medical system project which would benefit the livelihood of millions of peasants. During several years of experimental exploration, the western new rural cooperative medical system has played the proper role in alleviating the situation that the peasants get poor or return to poor due to sickness. However, some problems that need to be solved are exposed simultaneously. Empirical analysis from the perspective of the stakeholders shows that the peasants demand for cooperative medical intensely. However, the medical service supply is weak and Supply-induced Demand(SID) is excessive, and the public health service function is either inadequate or excessive, resulting from instability of the attending rate, the defect of rural medical service system, and the disproportion of health resource collocation. By the theoretical analysis of the root causes, there is restriction in the scope of macro operational circumstances, such as west humanistic and social circumstances, the reform of medical service system, systematic support and construction of complementary facilities. And there are intrinsic flaws in the scale of systematic design such as functional model, financing and compensation, supervision and management, and reimbursement system.In view of the restrictive factors of the sustainable development of the Western new rural cooperative medical system, we may establish and perfect west new rural cooperation medical system, through optimized financing compensation mechanism, the risk supervision and control mechanism, and the stakeholders'linkage mechanisms, in order to consummate the new rural cooperatives medical system. The key of optimized financing mechanism is to strengthen government's financial investment to the west cooperation medical system on the basis of specifying cooperative medical product's attributes, to determine financing ratio of every part, and to ensure the fairness of the financial mechanism, further more, to simultaneously formulate the scientific financing model in order to arouse the peasants'enthusiasm in participation. The key of optimized compensation mechanism is to expand the types of compensation, especially to include the outpatient service compensation into coverage scale, which could expand benefits scale, and to raise the proportion of compensation, specially to enlarges compensation proportion for common frequently-occurring disease in West China, which may enhance benefit rate, further more, to make sure that the attending peasants get real benefits.The operational risk of the new rural cooperative medical system mainly includes the risk of stakeholders and the risk of cooperative medical fund. We should improve the normative management mechanism, strengthen the supervising mechanism, and use incentive-restriction mechanism. We should also prevent and supervise the risk especially through the early warning of financial risk, the expense control of medical services'provider, and the supervision of peasants'attending. The continuous operation of Western new rural cooperative medical system should rely on main stakeholders'linkage mechanism. By the reform of the medicine health system, the allocation of human resource, the construction of information system of price and quality of service,we should construct medical services supply mechanism, remodel the dominant status consciousness of peasants attending, design the rational of participatory mechanisms and suitable training, promote the peasants' willingness and ability to participate, establish peasant's participation mechanism. And we should set up government's public service supplies mechanism through defining the government's functions of public service,the legislation to ensure the support mechanism, the institutional arrangements, and financial input mechanism.The main conclusions drawn through this paper are as follows: To realize the sustainable development, we must establish a new functional pattern of preventing minor illnesses and compensating severe illnesses, as the orientation for the new rural cooperative medical system; There is a big necessity to establish a diversified and multi-leveled rural medical service security system to ease the pressure from this new rural cooperative medical system; We should base the sustainable development of the cooperative medical system on the idea of"the leading role of government and the main status of peasants"and strengthen the security mechanism for the interests of all the participating peasants; A further improvement of the new rural cooperative medical system is needed, with the emphasis on strengthening the regulation of financing, compensation, management and supervision; The attention should be focused on the scheme of one special group, mainly flowing rural migrant workers, and the establishment of a long-term effective attending mechanism for this distressed group should be taken into consideration; We should figure out the management regulation for the new rural cooperative medical system as soon as possible and establish a horizontal cooperative network among relevant functional departments.The paper may have some innovations in the below aspects: First, in view of the reality of the economic backwardness, bad traffic condition and more endemic and chronic diseases of the western rural areas, a new orientation for the new rural cooperative medical system has been put forward, which is, to prevent the minor illnesses and compensate the severe illnesses; Second, the dual supply-demand relationship existing in the main body of the western new rural cooperative medical treatment is also proposed, which are, the supply-demand relationship between medical institutes and sick peasants and that between cooperative medical management office and the participating peasants; Third, a clear distinction and definition of the problems and root for the sustainable operation of the western new rural cooperative medical system has been made, as well as the regulation of management and supervision whose relationship can be elaborated as follows: management is the overall macro regulation for the cooperative medical operation, while supervision is the prevention, inspection and correction for the weak points prone to be questionable; Forth, based on the data analysis, a simple calculating model for financing and compensation proportion has been built, in order to better conduct a quantitative analysis of the standard proportion for the western new rural cooperative medical financing and compensation. However, there still exists some research gaps which need studying in depth, such as, the effective link between the cooperative medical regulation and other related security regulations, the quantitative analysis of the standard proportion for the financing and compensation in west provinces, the exploration of the effective way to a new independent rural cooperative medical supervision system, etc.